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Long-term outcomes of non-operative compared to operative management of acute uncomplicated appendicitis - a systematic review and meta-analysis.

Noam Kahana·Elad Boaz·Sameh Hany Emile·Petachia Reissman·Raul J Rosenthal·Steven D Wexner·Nir Horesh
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Abstract

BACKGROUND: We evaluated long-term outcomes of non-operative management (NOM) versus surgical management of acute uncomplicated appendicitis. METHODS: Systematic review of studies comparing NOM versus surgery with ≥2 years follow-up. Primary outcome was long-term failure rate. RESULTS: 9/1635 studies were included (3 RCTs; 6 non-RCT studies), involving 3883 patients; 5 were in pediatric populations. Median follow-up was 33.6 (range 24-312) months. NOM pooled long-term failure rate was 38.9% (95% CI: 31.1%-46.7%), increasing to 44.4% (95% CI: 41.4%-47.4%) in RCTs. Pooled appendectomy rate after NOM was 36.3% (95% CI: 28.9%-43.7%). Incidence of appendiceal neoplasms was approximately 0.3%. Non-operative management had cost savings of €1535 (95% CI: -€1892 to -€1178) versus surgery. CONCLUSIONS: NOM of acute uncomplicated appendicitis was associated with high long-term failure rates and significant risk of subsequent appendectomy.

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HumansAcute DiseaseAppendectomyAppendicitisConservative TreatmentTreatment OutcomeMalignancyNon-operative managementRecurrenceSurgeryComparative StudyJournal ArticleMeta-AnalysisSystematic Review

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Noam Kahana, Elad Boaz, Sameh Hany Emile, Petachia Reissman, Raul J Rosenthal, Steven D Wexner, Nir Horesh. 2026-08-18. Long-term outcomes of non-operative compared to operative management of acute uncomplicated appendicitis - a systematic review and meta-analysis.. https://doi.org/10.1016/j.amjsurg.2026.117203

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Acute Disease subjectComparative Study subjectHumans subjectJournal Article subjectMeta-Analysis subjectSystematic reviews study

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